Early Placement of Optional Vena Cava Filter in High-Risk Patients with Traumatic Brain Injury.

OBJECTIVES: Patients sustaining severe trauma are at high risk for the development of venous thromboembolic events (VTE). Pharmacologic VTE prophylaxis may be contraindicated early after trauma due to potential bleeding complications. The purpose of this study was to evaluate safety and feasibility of early prophylactic vena cava filter (VCF) placement and subsequent retrieval in multiple injured patients with traumatic brain injury (TBI). METHODS: Analysis of single-institution case series of consecutive patients who received a prophylactic VCF after severe TBI (Abbreviated Injury Scale, AiS ≥ 3) between August 2003 and October 2006. RESULTS: A total of 34 optional VCF were prophylactically placed with a median delay of 1 day after trauma (range, 0-7 days). All patients had sustained multiple injuries (median Injury Severity Score 41, range, 18-59) with severe TBI (median AiS 4, range 3-5). Median age was 41 years (range, 17-67 years). Two patients had succumbed before potential filter retrieval. Of the remaining patients, 27 (84%) had their filters uneventfully retrieved between 11 and 32 days (median, 18 days) after placement with no retrieval-related morbidity. Five VCF (16%) were left permanently. In one patient (3%) early inferior vena cava occlusion and deep venous thrombosis occurred 14 days after VCF placement. Symptomatic pulmonary embolism was observed in one patient (3%) 5 days after VCF retrieval. Overall trauma-related mortality was 9%. CONCLUSIONS: Early VCF placement may be of benefit for multiple injured patients with TBI when pharmacologic VTE prophylaxis is contraindicated. VCF retrieval is safe and feasible. Filter placement- and retrieval-related morbidity is low.

Correlation between the efferent venous drainage of the tumor and peritumoral edema in intracranial meningiomas: superselective angiographic analysis of 25 cases.

OBJECT: The extent of peritumoral brain edema (PTBE) associated with meningiomas can be highly variable. The authors studied the correlation between the development of efferent venous drainage from the tumor and the degree of PTBE that occurs in intracranial meningiomas. METHODS: Twenty-five patients with 27 intracranial supratentorial meningiomas were investigated to identify the correlation between the efferent venous drainage system of the tumor and peritumoral edema. The overall mean age of the patients was 54 years. Seventeen patients (68%) were female and eight (32%) were male. All patients underwent magnetic resonance imaging and digital subtraction angiography. In each meningioma, superselective angiography of the dominant feeding artery was performed, including the late venous phase to evaluate the development of the tumor's draining vein. An edema index (EI) was introduced to serve as an objective means by which to judge the extent of PTBE. Eleven meningiomas (41%), in which the mean EI was 0.14 +/- 0.10, clearly showed dominant draining veins originating from the tumor itself. In the other 16 meningiomas (59%), superselective angiography demonstrated no efferent venous drainage from the tumor, which could account for this group's mean EI value of 1.49 +/- 1.05 (p < 0.001). CONCLUSIONS: The current results suggest that hypoplasia of the efferent draining vein from the meningioma itself contributes to PTBE formation. The development of an efferent venous system mitigates against the formation of PTBE. Intratumoral venous congestion can be considered the main cause of PTBE in meningiomas.

Growth retardation and bilateral cataracts followed by anaplastic meningioma 23 years after high-dose cranial and whole-body irradiation for acute lymphoblastic leukemia: case report and review of the literature.

We report a case of meningioma diagnosed 23 years after high-dose cranial and whole-body irradiation for the treatment of acute lymphocytic leukemia (ALL). Radiotherapy in this case also caused early radiation injury to the lenses and the pituitary gland, with growth retardation and mineralizing angiopathy. Radiation-induced meningiomas are more commonly malignant, more commonly multiple, and more likely to recur after resection than non-radiation-induced meningiomas. Survivors of childhood ALL treated with high-dose cranial irradiation are at risk both for early radiation injury in radiosensitive organs, such as the lens and pituitary gland, and for the later development of a radiation-induced meningioma.